ABSTRACT

A method of utilizing vitamin C in amounts just short of the doses which produce
diarrhea is described (TITRATING TO BOWEL TOLERANCE). The amount of oral ascorbic acid
tolerated by a patient without producing diarrhea increases somewhat proportionately to
the stress or toxicity of his disease. Bowel tolerance doses of ascorbic acid ameliorate
the acute symptoms of many diseases. Lesser doses often have little effect on acute
symptoms but assist the body in handling the stress of disease and may reduce the
morbidity of the disease. However, if doses of ascorbate are not provided to satisfy this
potential draw on the nutrient, first local tissues involved in the disease, then the
blood, and then the body in general become deplete of ascorbate (ANASCORBEMIA and ACUTE
INDUCED SCURVY). The patient is thereby put at risk for complications of metabolic
processes known to be dependent upon ascorbate.

INTRODUCTION

Over the past ten-year period I have treated over 9,000 patients with large doses of
vitamin C (Cathcart 1, 2, 3,
4, 5). The effects of this substance when used in adequate
amounts markedly alters the course of many diseases. Stressful conditions of any kind
greatly increase utilization of vitamin C. Ascorbate excreted in the urine drops markedly
with stresses of any magnitude unless vitamin C is provided in large amounts. However, a
more convenient and clinically useful measure of ascorbate need and presumably utilization
is the BOWEL TOLERANCE. The amount of ascorbic acid which can be taken orally without
causing diarrhea when a person is ill sometimes is over ten times the amount he would
tolerate if well. This increased bowel tolerance phenomenon serves not only to indicate
the amount which should be taken but indicates the unsuspected and astonishing magnitude
of the potential use that the body has for ascorbate under stressful conditions.

If this massive draw on the small ascorbate stores of the body is not fully satisfied,
the condition of ANASCORBEMIA results. The deficit of ascorbate probably starts in the
tissues directly involved in the disease and then spreads to other tissues of the body. A
condition of localized and then systemic acute scurvy is produced. This ACUTE INDUCED
SCURVY leads to poor healing and ultimately to complications involving other systems of
the body.

Much of the original work with large amounts of vitamin C was done by Fred R. Klenner,
M.D. (6, 7, 8, 9) of Reidsville, North Carolina. Klenner found that viral diseases could
be cured by intravenous sodium ascorbate in amounts up to 200 grams per 24 hours. Irwin
Stone (10, 11, 12) pointed out the potential of vitamin C in the treatment of many
diseases, the inability of humans to synthesize ascorbate, and the resultant condition hypoascorbemia. Linus Pauling (13,
14) reviewed the literature on vitamin C and has led
the crusade to make known its medical uses to the public and the medical profession. Ewan
Cameron in association with Pauling (15, 16,
17) has shown the usefulness of ascorbate in
the treatment of cancer.

In 1970, I discovered that the sicker a patient was, the more ascorbic acid he would
tolerate by mouth before diarrhea was produced. At least 80% of adult patients will
tolerate 10 to 15 grams of ascorbic acid fine crystals in 1/2 cup water divided into 4
doses per 24 hours without having diarrhea. The astonishing finding was that all patients,
tolerant of ascorbic acid, can take greater amounts of the substance orally without having
diarrhea when ill or under stress. This increased tolerance is somewhat proportional to
the toxicity of the disease being treated. Tolerance is increased some by stress (e.g.,
anxiety, exercise, heat, cold, etc.)(see FIGURE I). Admittedly, increasing the frequency
of doses increases tolerance perhaps to half again as much, but the tolerances of
sometimes over 200 grams per 24 hours were totally unexpected. Representative doses taken
by tolerant patients titrating their ascorbic acid intake between the relief of most
symptoms and the production of diarrhea were as follows:

1) Note that disease symptom curves indicate very little effect on acute
symptoms until doses of 80-90% of bowel tolerance are reached. Perhaps it is only near
tolerance doses that the ascorbate is pushed into the primary sites of the disease. 2)
Suppression of symptoms in some instances may not be total; but usually it is very
significant and often the amelioration is complete and rapid. 3) Hepatitis may require 30
to 100 grams.

The maximum relief of symptoms which can be expected with oral doses of
ascorbic acid is obtained at a point just short of the amount which produces diarrhea. The
amount and the timing of the doses are usually sensed by the patient. The physician should
not try to regulate exactly the amount and timing of these doses because the optimally
effective dose will often change from dose to dose. Patients are instructed on the general
principles of determining doses and given estimates of the reasonable starting amounts and
timing of these doses. I have named this process of the patient determining the optimum
dose, TITRATING TO BOWEL TOLERANCE. The patient tries to TITRATE between that amount which
begins to make him feel better and that amount which almost but not quite causes diarrhea.

I think it is only that excess amount of ascorbate not absorbed into the
body which causes diarrhea; what does not reach the rectum, does not cause diarrhea.

It is interesting to know, when one speculates on the exact cause of this
diarrhea, that while a hypertonic solution of sodium ascorbate is being administered
intravenously, the amount of ascorbic acid tolerated orally actually increases.

When a person is ill the amount of ascorbic acid he can ingest without
diarrhea being produced increases somewhat proportionally to the severity or the toxicity
of the disease. A cold severe enough to permit a person to take 100 grams of ascorbic acid
per 24 hours during the peak of the disease, I call a 100 GRAM COLD.

Perhaps one of the most important principles in ORTHOMOLECULAR MEDICINE is
BIOCHEMICAL INDIVIDUALITY (18). Every individual responds to substances differently.
Vitamin C is no exception. However, at least 80% of my patients tolerated ascorbic acid
well. Admittedly, there were relatively few older patients in my practice. Infants, small
children, and teenagers tolerate ascorbic acid well and can take, proportionate to their
body weight, larger amounts than adults. Older adults tolerate lesser amounts and have a
higher percentage of nuisance difficulties. Patients with multiple food intolerances may
have more difficulties but should attempt taking ascorbate because of benefits often
obtained.

For several years while I was treating only sick people with ascorbic
acid, I was unaware of the number of people who had nuisance problems with maintenance
doses. The tolerance of the sick person to ascorbate is so high as to prevent many of the
complaints one would have if he were well. When ascorbic acid is prescribed to a sick
person, the beneficial effect is obvious enough so that few complain of the gas and
diarrhea. With illness the effects of an overdose do not last long because of the rapid
rate of utilization.

It is important for the physician to understand the principles of treating
this vast majority of tolerant persons. Patients frequently underdose themselves and need
professional guidance to push the doses to effective levels. The small number of persons,
especially elderly persons, intolerant to oral doses are in my experience able to take
intravenous ascorbate without difficulties. Additionally, patients with severe problems
may need to be treated intravenously if very high doses will have to be maintained for
some time for adequate suppression of symptoms.

It is well established that certain symptoms are associated with an almost
total lack of vitamin C within the body. Symptoms of scurvy include lassitude, malaise,
bleeding gums, loss of teeth, nosebleeds, bruising, hemorrhages in any part of the body,
easy infections, poor healing of wounds, deterioration of joints, brittle and painful
bones, and death, etc. It is thought that this disease only occurs with dietary
deprivation of vitamin C. However, an analogous condition is produced as follows:

Well-nourished humans usually contain not much more than 5 grams of
vitamin C in their bodies. Unfortunately, the majority of people have far less ascorbate
than this amount in their bodies and are at risk for many problems related to failure of
metabolic processes dependent upon ascorbate. This condition is called CHRONIC SUBCLINICAL
SCURVY (12).

If a disease is toxic enough to allow for the person's potential
consumption of 100 grams of vitamin C, imagine what that disease must be doing to that
possible 5 grams of ascorbate stored in the body. A condition of ACUTE INDUCED SCURVY is
rapidly induced. Some of this increased metabolic need for ascorbate undoubtedly occurs in
areas of the body not primarily involved in the disease and can be accounted for by such
functions as the adrenals producing more adrenaline and corticoids; the immune system
producing more antibodies, interferon (19, 20), and other substances to fight the
infection; the macrophages utilizing more ascorbate with their increased activity; and the
production and protection of c-AMP and c-GMP with the subsequent increased activity of
other endocrine glands (21), etc. Also, there must be a tremendous draw on ascorbate
locally by increased metabolic rates in the primarily infected tissues. The infecting
organisms themselves liberate toxins which are neutralized by ascorbate, but in the
process destroy ascorbate. The levels of ascorbate in the nose, throat, eustachian tubes,
and bronchial tubes locally infected by a 100 gram cold must be very low indeed. With this
acute induced scurvy localized in these areas, it is small wonder that healing can be
delayed and complications such as chronic sinusitis, otitis media, and bronchitis, etc.
develop.

I had assumed that much of this ascorbate was used for functions somehow
directly related to neutralizing the toxicity of viral and bacterial diseases. When ill,
one has the internal sense that something of this nature is happening when bowel tolerance
is approached. Recently, however, I had the personal experience of ingesting 48 grams in
an hour and a half when I had a sudden hay fever reaction to roses. Upon withdrawal from
the roses tolerance dropped rapidly to normal. This experience plus my experiences with
many patients under emotional stress, would indicate that the adrenals are capable of
utilizing large amounts of ascorbate with benefit if it is made available.

This draw on ascorbate, from whatever source, lowers the blood level of
ascorbate to a negligible level. I have coined the term ANASCORBEMIA for this condition.
If this anascorbemia is not rapidly rectified by the oral administration of bowel
tolerance doses of ascorbic acid or by intravenous administration of ascorbate, the
remainder of the body is rapidly depleted of ascorbate and put at risk for disorders of
the metabolic processes dependent upon vitamin C.

The following problems should be expected with increased incidence with
severe depletion of ascorbate: disorders of the immune system such as secondary
infections, rheumatoid arthritis and other collagen diseases, allergic reactions to drugs,
foods and other substances, chronic infections such as herpes, or sequelae of acute
infections such as Guillain-Barre' and Reye's syndromes, rheumatic fever, or scarlet
fever; disorders of the blood coagulation mechanisms such as hemorrhage, heart attacks,
strokes, hemorrhoids, and other vascular thrombosis; failure to cope properly with
stresses due to suppression of the adrenal functions such as phlebitis, other inflammatory
disorders, asthma and other allergies; problems of disordered collagen formation such as
impaired ability to heal, excessive scarring, bed sores, varicose veins, hernias, stretch
marks, wrinkles, perhaps even wear of cartilage or degeneration of spinal discs; impaired
function of the nervous system such as malaise, decreased pain tolerance, tendency to
muscle spasms, even psychiatric disorders and senility; and cancer from the suppressed
immune system and carcinogens not detoxified; etc. Note that I am not saying that
ascorbate depletion is the only cause of these disorders, but I am pointing out that
disorders of these systems would certainly predispose to these diseases and that these
systems are known to be dependent upon ascorbate for their proper function.

Not only is there the theoretical probability that these types of
complications associated with infections or stresses could result from ascorbate
depletion, but there was a conspicuous decrease in the expected occurrence of
complications in the thousands of patients treated with oral tolerance doses or
intravenous doses of ascorbate. This impression of marked decrease in these problems is
shared by physicians experienced with the use of ascorbate such as Klenner (8,
9) and
Kalokerinos (22).

Stone (11) has described the genetic defect whereby the higher primates
lost the ability to synthesize ascorbate. This defect is caused by a mutated defective
gene for the liver enzyme, L-gulonolactone oxidase. The higher mammals (except for the
higher primates) developed a feedback mechanism which increases ascorbate synthesis under
the influence of external and internal stresses (23).

There are many well-established functions of vitamin C that help in the
handling of stress. When stressed, the higher mammals can augment these functions by this
feedback mechanism. For the higher primates, including humans, ascorbate can amount to the
MISSING STRESS HORMONE (4).

I have seen strong clinical evidence that not only does the bowel
tolerance to ascorbate increase under stress but that fully satisfying that potential use
for ascorbate markedly reduces secondary diseases and complications following stress or
primary disease. Since 1970, with teaching the bowel tolerance method of determining
proper ascorbic acid doses to patients, I have not had to hospitalize a single patient for
an acute viral disease or a complication from such a disease if the patient utilized the
method. In some cases, such as with three cases of viral pneumonia, it was necessary to
utilize intravenous ascorbate. Admittedly, I have been lucky because no patient has
arrived with such severe symptoms as to necessitate immediate hospitalization. There have
been many patients where there was no question that they would have required
hospitalization in a very short period of time had not ascorbate been administered. Some
patients not quite taking bowel tolerance doses, but taking significantly large doses of
ascorbate, would not have as dramatic suppression of acute symptoms but would,
nevertheless, avert complications.

Acute mononucleosis is a good example because there is such an obvious
difference between the course of the disease, with and without ascorbate. Also, it is
possible to obtain laboratory diagnosis to verify that it is mononucleosis being treated.
Early in this study a 23-year-old, 98-pound librarian with severe mononucleosis claimed to
have taken 2 heaping tablespoons every 2 hours, consuming a full pound of ascorbic acid in
2 days. She felt mostly well in 3 to 4 days, although she had to continue about 20 to 30
grams a day for about 2 months.

Many cases do not require maintenance doses for more than 2 to 3 weeks.
The duration of need can be sensed by the patient. I had ski patrol patients back skiing
on the slopes in a week. They were instructed to carry their boda bags full of ascorbic
acid solution as they skied. The ascorbate kept the disease symptoms almost completely
suppressed even if the basic infection had not completely resolved. The lymph nodes and
spleen returned to normal rapidly and the profound malaise was relieved in a few days. It
is emphasized that tolerance doses must be maintained until the patient senses he is
completely well, or the symptoms will recur.

Acute cases of infectious hepatitis have responded dramatically. Cases
included two orthopaedic surgeons who probably acquired the disease pricking their hands
at surgery and being inoculated with a patient's blood. With ascorbate treatment
laboratory tests including the SGOT, SGPT, and bilirubins indicated rapid reversal of the
disease. In one of these cases, with the doctorpatient and his treating physicians having
difficulty believing that the ascorbate was responsible for the improvement, the ascorbate
was discontinued. The condition of the patient rapidly deteriorated. The patient's wife
took charge and doled out the ascorbate; again the disease rapidly subsided with
laboratory findings returning to normal.

Usually oral bowel tolerance doses will reverse hepatitis rapidly. Stools
regularly return to normal color in 2 days. It generally takes about 6 days for the
jaundice to clear, but the patient will feel almost well after 4 to 5 days. Because of the
diarrhea caused by the disease, intravenous ascorbate may need to be used in very severe
cases. Often large doses of ascorbic acid, taken orally despite diarrhea, will cause a
paradoxical cessation of the diarrhea.

Morishige has demonstrated the effectiveness of ascorbate in preventing
hepatitis from blood transfusions (24).

The phenomenon of symptoms returning repeatedly if the ascorbate is not
continued in high doses is most convincing. It is possible to have symptoms come and go
many times. In fact, there is often a feeling when titrating to bowel tolerance that
symptoms are beginning to return just before taking the next dose.

Often a patient will sense that he is probably catching some viral disease
and that he is in need of large doses of ascorbic acid. If he is experienced in taking
ascorbic acid he may be able to suppress more than 90% of the symptoms. He feels that he
should take large amounts of ascorbate, does not feel quite right, and may have peculiar
mild symptoms. I call this condition UNSICK. Recognition of this state is important
because it can be mistaken for more serious conditions.

Symptoms from acute viral diseases can most frequently be more permanently
eliminated with intravenous sodium ascorbate. While it is true that tolerance doses of
oral ascorbate will usually eliminate complications of acute viral diseases; at times,
such as with certain cases of influenza, the large amount of oral ascorbate necessary to
suppress symptoms over a period of a week or more, sometimes makes intravenous ascorbate
desirable. Clinically large amounts of ascorbate used intravenously are virucidal (2,
5,
7, 8).

The sodium ascorbate used intravenously and intramuscularly must contain
no preservatives. Usually there is only a small amount of EDTA in the preparation to
chelate trace amounts of copper and iron which might destroy the ascorbate. Solutions
containing sodium ascorbate 250 or 500 mgm per cc can be obtained. The 250 mgm solutions
may be used in young children intramuscularly in doses usually 350 mgm/kg body weight up
to every 2 hours. When the volume of the material becomes too great for intramuscular
injections, then the intravenous route should be used. Inadequate doses will be
ineffective. Quite frequently a child initially refusing oral ascorbate will cooperate
after injections if given the alternative. While this method of persuasion seems cruel, it
is better than the complications which might otherwise occur. These intramuscular
injections can be used in a crisis situation. Kalokerinos (22) describes cases where
certain death in infants already in shock has been averted by emergency intramuscular
ascorbate.

For intravenous solutions concentrations of 60 grams per liter are made
with the 250 or 500 mgm/cc sodium ascorbate diluted with Ringer's lactate, 1/2N saline, 1N
saline, D5W, or distilled water for injection. I prefer the latter, but one has to be
absolutely sure that an error is not made and pure water given. Ascorbate is more
efficient intravenously than orally probably because chemical processes in the gut destroy
a percentage of that orally administered. Doses of 400 to 700 mgm/kg of body weight per 24
hours usually suffice. Rate of infusion and the total amount administered can be
determined by making sure that symptoms are suppressed and that the patient not become
dehydrated or receive sodium too rapidly. Local soreness in the vein caused by too rapid
infusion is relieved by slowing the intravenous infusion. One gram of calcium gluconate
should be added to the bottles each day to prevent tetany.

I have not yet seen a case of phlebitis develop as a result of ascorbate
administration. This rarity of phlebitis possibly suggests that this condition sometimes
has something to do with ascorbate depletion.

Frequently I have the patient take oral doses of ascorbic acid at the same
time he is taking intravenous sodium ascorbate. Bowel tolerance is actually increased by
concomitant use of intravenous ascorbate. Care and experience is necessary with
concomitant use because tolerance drops precipitously when the intravenous infusion is
discontinued.

Ascorbic acid should be used with the appropriate antibiotic. The effect
of ascorbic acid is synergistic with antibiotics and would appear to broaden the spectrum
of antibiotics considerably. I found that penicillin-K orally or penicillin-G
intramuscularly used in conjunction with bowel tolerance doses of ascorbic acid would
usually treat infections caused by organisms ordinarily requiring ampicillin or other more
modern synthetic penicillins. Cephalosporins were used in conjunction with ascorbic acid
for staphylococcus infections. The combination of tetracycline and ascorbate was used for
nonspecific urethritis; however, patients who had previously repeated recurrences of
nonspecific urethritis found they were free of the disease with maintenance doses of
ascorbate. I am not sure that the tetracycline was necessary even in the acute cases, but
it was used for legal reasons. Some other cases of unknown etiology such as two cases of
Reiter's disease and one case of acute anterior uveitis also responded dramatically to
ascorbate.

A most important point is that patients with bacterial infections would
usually respond rapidly to ascorbic acid plus a basic antibiotic determined by initial
clinical impressions. If cultures subsequently proved the selection of antibiotic
incorrect, usually the patient was well by that time.

In the case of a 45-year-old man who had developed osteomyelitis of the
5th metacarpal of the right hand following a cat bite, a partial amputation of the hand
had been recommended and surgery scheduled. Consultants agreed. The patient delayed
surgery and signed himself out of the hospital. He was given intravenous ascorbate 50
grams a day for 2 weeks. The infection resolved rapidly. While this patient had
destruction of the distal end of the metacarpal, there has been no recurrence of the
infection (25).

This case illustrates the frequent problem of an indolent infection with
an organism non-responsive to the most sophisticated antibiotic treatment which then may
respond rapidly to treatment with intravenous ascorbate.

Treating simultaneously with the appropriate antibiotic plus ascorbate has
the additional advantage that if, unexpectedly, the infection is actually viral, the
infection will be suppressed and the incidence of allergic reaction to the antibiotic
reduced.

Patients seemed not to develop their first allergic reaction to penicillin
when they had taken bowel tolerance ascorbate for several doses. Among the several
thousand patients given penicillin, two cases of brief rash were seen in patients who had
taken their first dose of penicillin along with their first dose of ascorbate. If one
understands the reasons for bowel tolerance doses of ascorbate, it is obvious that these
patients were not as yet "saturated." I saw three patients who had taken
penicillin without ascorbate who had developed an urticarial rash. These cases rapidly
responded to oral ascorbic acid. Only a single dose of antihistamine was usually used. I
would have anticipated longer reactions in most of these cases. I saw one case of a
delayed serum sickness type of penicillin reaction in a ten-year-old girl who had not
taken ascorbate previously. The rash in this patient did not immediately respond to
ascorbic acid. The rash took about two weeks to completely resolve; however, if the
ascorbate was not taken regularly to tolerance, the rash would worsen. It was difficult to
maintain high doses in this patient.

Patients who had known-previous-allergic reactions to penicillin were
never given the antibiotic anticipating that vitamin C would protect them. I suspect that
the deficit of body ascorbate produced by disease may have something to do with
malfunction of the immune system and the development of allergies. However, whether
ascorbate may give some protection from an antibiotic known previously to cause an
allergic reaction in a patient, when subsequent reactions might involve anaphylaxis, is a
question which must be approached very carefully. Certainly, inadequate doses of ascorbate
could be disastrous.

Patients with mononucleosis, untreated with ascorbate, have a very high
incidence of allergic reaction to penicillin. It is interesting that this same disease
seems to cause some of the highest bowel tolerances of any disease.

As can be seen from the previous discussion of the increasing bowel
tolerance phenomenon, there is undoubtedly increased utilization of ascorbate under
stressful conditions. If this increased utilization creates a deficit, there may be
malfunctions of various systems of the body such as the immune system which are dependent
on ascorbate. Therefore, it should not be surprising that certain malfunctions of the
immune system and adrenal glands associated with stress might be ameliorated by ascorbate.

Hay fever is controlled in the majority of patients. Bowel tolerance doses
are usually required only at the peak of the season; otherwise, more modest doses suffice.
Many patients find the effect of ascorbate more satisfactory than immunizations or
antihistamines and decongestants. The dosages required are frequently proportional to
exposure to the antigen.

Asthma is most often relieved by bowel tolerance
doses of ascorbate. A child regularly having asthmatic attacks following exercise is
usually relieved of these attacks by large doses of ascorbate. So far all of my patients
having asthmatic attacks associated with the onset of viral diseases have been ameliorated
by this treatment.

Large clinical studies will be necessary to prove this point, but for now
prudent practice would be to take large doses ofascorbate when stressed or when ill.

This theory begins to make some sense of the observation that many
patients will develop allergic disorders or other diseases following combinations of
stress, disease, and malnutrition. Immunologists should be particularly interested in the
control of these allergic problems and particularly the dramatic responses of cases of
ankylosing spondylitis, Reiter's disease, and acute anterior uveitis. All three of these
problems have a high association with the HLA-B27 antigen. The possibility that ascorbate
might have some value in controlling the immune response at the gene level should be
thoroughly investigated because there could be some basic implications in
histocompatibility (graft acceptance), cancer control, and destruction of foreign
invaders. Ascorbate would appear to help stabilize some homeostatic mechanisms.

Yeast infections occur less frequently in patients treated with
antibiotics if bowel tolerance doses of ascorbic acid are simul- taneously used. Ascorbic
acid seems to reduce the systemic toxicity considerably but does not eliminate the primary
infection. It has been helpful to patients with allergic problems secondary to candida.

Although ascorbic acid should be given in some form to all sick patients
to help meet the stress of disease, it is my experience that ascorbate has little effect
on the primary fungal infections. Systemic toxicity and complications can be reduced in
incidence. It may be found that appropriate antifungal agents will better penetrate
tissues saturated in ascorbate.

Swelling and pain from trauma, surgery, and burns are markedly reduced by
bowel tolerance doses of ascorbic acid. Doses should be given a minimum of 6 times a day
for trauma and surgery. Burns can require hourly doses. Serious burns, major trauma, and
surgery should be treated with intravenous ascorbate. The effect of ascorbate on
anesthetics should be studied. Barbiturates and many narcotics are blocked, (26) so their
use as anesthetic agents will be limited when ascorbate is used during surgery. While
practicing orthopaedic surgery, I had some experience with trauma cases in which I used
ascorbic acid post-operatively. There was virtual elimination of confusion in elderly
patients following major surgeries such as with hip fractures when ascorbate was given.
This confusion is commonly ascribed to fat embolization and the subsequent inflammation
provoked in the tissues by the emboli. I did several menisectomies where one knee had been
done before vitamin C was used, and the other side after vitamin C was used. The pain and
post-operative recovery time were lessened considerably. The amount of inflammation and
edema following injury and surgery were markedly reduced. The pain medications used were
relatively minimal. My limited experience in replacing skin flaps avulsed by trauma
indicated a whole degree of lessened difficulties with much greater success.

Anyone who has done animal surgery other than on humans is impressed by
the rapid recovery rate. Humans loaded with ascorbate would appear to recover similarly to
the animals which make their own ascorbate in response to stress. In the past, vitamin C
administered to patients in hospitals post-operatively has been in trivial amounts never
exceeding several grams. I predict that reimplantations of major amputations, even
transplant surgeries, and especially fine surgeries of the eyes, ears, or fingers will
enjoy a phenomenal increase in success rate when ascorbate is utilized in doses of 100
grams or more per 24 hours.

The limited stress-coping mechanisms of humans seems to be the result of
rapid ascorbate depletion. With surgery this leads to vascular thrombosis, hemorrhage,
infection, edema, drug reactions, shock, adrenal collapse with limited adrenaline and
steroid production, etc.

I have avoided the treatment of cancer patients for legal reasons;
however, I have given nutritional consults to a number of cancer patients and have
observed an increased bowel tolerance to ascorbic acid. Were I treating cancer patients, I
would not limit their ascorbic acid ingestion to a set amount but would titrate them to
bowel tolerance. Ewan Cameron's advice against giving cancer patients with widespread
metastasis large amounts of ascorbate too rapidly at first should be heeded. He found that
sometimes extensive necrosis or hemorrhage in the cancer could kill a patient with
widespread metastasis if the vitamin was started too rapidly (16). Hopefully, in the
future ascorbic acid will be among the initial treatments given cancer patients. The
additional nutritional needs of cancer patients are not limited to ascorbic acid, but
certainly the stress involved with having the disease depletes ascorbate levels in the
body. Ascorbate should be used in cancer patients to avert disorders of ascorbate
deficiency in various systems of the body including the immune system.

Greenwood (27) observed that 1 gram a day would reduce the incidence of
necessary surgery on discs. At bowel tolerance levels, ascorbic acid reduces pain about
50% and lessens the difficulties with narcotics and muscle relaxants (2). It is not,
however, the only nutritional support that patients with back pain should receive.

Bowel tolerance is not increased by degenerative arthritis although
occasionally ascorbate has some beneficial effect.

Ankylosing spondylitis and rheumatoid arthritis do increase tolerance.
Clinical response varies. Norman Cousins (28) curing his own ankylosing spondylitis with
ascorbate is not unexpected. With these and other collagen diseases, food and chemical
allergies can sometimes be found. It may be that the blocking of allergic reactions with
augmented adrenal function is one of the reasons these patients are sometimes benefitted.

Three cases with typical sandpaper-like rash, peeling skin, and diagnostic
laboratory findings of scarlet fever have responded within an hour or overnight. I think
this immediate response is due to the neutralization of the small amount of streptococcus
toxin responsible for the disease. Although I have not seen a case of acute rheumatic
fever, I would anticipate rapid effects.

Acute herpes infections are usually ameliorated with bowel tolerance doses
of ascorbic acid. However, recurrences are common especially if the disease has already
become chronic. Zinc in combination with ascorbic acid is more effective for herpes;
however, caution and regular monitoring of patients on zinc should be done.

I would agree with Kalokerinos (22) and Klenner (8) that crib deaths are
often caused by sudden ascorbate depletions. The induced scurvy in some vital regulatory
center kills the child. This induced deficiency is more likely to occur when the diet is
poor in vitamin C. All of the epidemiologic factors predisposing to crib deaths are
associated with low vitamin C intake or high vitamin C destruction.

Maintenance doses are established by the patient taking bowel tolerance
doses 6 times a day for at least a week. He observes if there is any unexpected benefit
such as clearing of sinuses, decrease in allergies, increase in energy, etc. Should any
chronic problem be benefitted, then the dose is decreased to the minimum amount producing
the effect. Otherwise a dose such as 4 to 10 grams a day divided in 3 to 4 doses is
recommended.

In addition, the patient is told to increase the dose on stressful days.
If a patient well tolerates ascorbic acid dissolved in water, then after a short period of
time his taste will begin to regulate the dosages. Most patients can easily sense their
ascorbate needs.

Patients who take ascorbate in large amounts over a long period of time
should probably suppliment with vitamin A and a multiple mineral preparation. The
"Fortified Formulation for Nutritional Insurance" of Roger Williams (29) is
recommended as a base.

It is my experience that ascorbic acid probably prevents most kidney
stones. I have had a few patients who had had kidney stones before starting bowel
tolerance doses who have subsequently had no more difficulty with them. Acute and chronic
urinary tract infections are often eliminated; this fact may remove one of the causes of
kidney stones. Six patients have had mild pain on urination; five of these patients were
over fifty and none had stones.

Three out of thousands had a light rash which cleared with subsequent
doses. It was difficult to evaluate the cause of this because of concomitant infections.
Several patients had discoloration of the skin under jewelry of certain metals. A few
patients complaining of small sores in the mouth with the taking of small doses of
ascorbate had them clear with bowel tolerance doses.

Patients with hidden peptic ulcers may have pain, but some are benefitted.
Mineral ascorbates can be used for maintenance doses in these cases. Two patients who had
mild epigastric discomfort with maintenance doses of ascorbic acid who after being given
ascorbate by vein for several days were then able to tolerate the acid orally.

It is my experience that high maintenance doses reduce the incidence of
gouty arthritis. I have not seen difficulties with giving large amounts of ascorbic acid
to patients with gout. Almost all my patients have been Caucasian, so I have no comment on
the report that ascorbate can cause certain blood problems in certain non-white groups
(30).

There has been no clinical evidence as Herbert and Jacob (31) suspected
that ascorbic acid destroys vitamin B12.

If maintenance doses of ascorbic acid in solution are used over very long
periods of time I would rinse the teeth after each dose. I would not brush my teeth with
calcium ascorbate.

There is a certain dependency on ascorbic acid that a patient acquires
over a long period of time when he takes large maintenance doses. Apparently, certain
metabolic reactions are facilitated by large amounts of ascorbate and if the substance is
suddenly withdrawn, certain problems result such as a cold, return of allergy, fatigue,
etc. Mostly, these problems are a return of problems the patient had before taking the
ascorbic acid. Patients have by this time become so adjusted to feeling better that they
refuse to go without ascorbic acid. Patients do not seem to acquire this dependency in the
short time they take doses to bowel tolerance to treat an acute disease. Maintenance doses
of 4 grams per day do not seem to create a noticeable dependency. The majority of patients
who take over 10-15 grams of ascorbic acid per day probably have certain metabolic needs
for ascorbate which exceed the universal human species need. Patients with chronic
allergies often take large maintenance doses.

The major problem feared by patients benefiting from these large
maintenance doses of ascorbic acid is that they may be forced into a position where their
body is deprived of ascorbate during a period of great stress such as emergency
hospitalization. Physicians should recognize the consequences of suddenly withdrawing
ascorbate under these circumstances and be prepared to meet these increased metabolic
needs for ascorbate in even an unconscious patient. These consequences of ascorbate
depletion which may include shock, heart attack, phlebitis, pneumonia, allergic reactions,
increased susceptibility to infection, etc., may be averted only by ascorbate. Patients
unable to take large oral doses should be given intravenous ascorbate. All hospitals
should have supplies of large amounts of ascorbate for intravenous use to meet this need.
The millions of people taking ascorbic acid makes this an urgent priority. Patients should
carry warnings of these needs in a card prominently displayed in their wallets or have a
Medic Alert type bracelet engraved with this warning.

CONCLUSION

The method of titrating a patient's dosage of ascorbic acid between the
relief of most symptoms and bowel tolerance has been described. Either this titration
method or large intravenous doses are absolutely necessary to obtain excellent results.
Studies of lesser amounts are almost useless. The oral method cannot by its very nature be
investigated by double blind studies because no placebo will mimic this bowel tolerance
phenomenon. The method produces such spectacular effects in all patients capable of
tolerating these doses, especially in the cases of acute self-limiting viral diseases, as
to be undeniable. A placebo could not possibly work so reliably, even in infants and
children, and have such a profound effect on critically ill patients. Belfield (32) has
had similar results in veterinary medicine curing distemper and kennel fever in dogs with
intravenous ascorbate. Although dogs produce their own ascorbate, they do not produce
enough to neutralize the toxicity of these diseases. This effect in animals could hardly
be a placebo.

It would be possible to conduct a double blind study on intravenous
ascorbate; however, doses would have to be determined by someone experienced with this
method.

Part of the difficulty many have with understanding ascorbate is that
claims for its benefits seem too many. Most of these clinical results merely indicate that
large doses of ascorbate augment the healing abilities of the body already known to be
dependent upon minimal doses of ascorbate.

I anticipate that other essential nutrients will be found being utilized
at unsuspectedly rapid rates in disease states. Compli- cations caused by failures in
systems dependent upon those nutrients will be found. The magnitude of supplimentations
necessary to avert those complications will seem extraordinary by standards accepted
today.

24. Murata, A. Virucidal activity of vitamin C: Vitamin C for the
prevention and treatment of viral diseases. Proceedings of the First Intersectional
Congress of Microbiological Societies, Science Council of Japan, 3:432-442, 1975.